Jim Kimmel and a Caremark computer glitch

John Curry to Jim Kimmel, November 22, 2006

Subject: Caremark computer glitch

Jim, thanks for sharing your story.

For the STRS to have signed a contract with a PBM (Caremark) that is full of "trade secrets" with little or no transparency and who pays their CEO in the hundreds of millions of dollars annually, THIS SHOULD NOT BE TOLERATED.

For some fun, ask Damon Asbury if you are allowed to read the full STRS/Caremark contract with him and see what he says! Warren Co. Retired Teachers Association (Nancy Hamant) even took the question of PBM Rx pricing to court for Rx pricing and it was thrown out due to a PBM industry nationwide (with the approval of Congress) "lockdown" (or, as they call it, trade secrets) on contractual information and pricing between PBM's and their contractors due to laws written by and favored for the pharmaceutical and PBM industry. In short, the consumer has and is getting the short end of the stick and the fat cats are getting fatter.

With a new majority in Congress, some of this will begin to change: more pharmaceutical manufacturers and PBM's will be investigated, more out-of-court settlements will be made, more executives will be taken to court for engineering ("back dating") of stock options, and some executives will see some actual "hard time" behind bars. A case in point, watch New York State where their former Attorney General Eliot Spitzer has been elected to Governor. AG Spitzer was the kiss of death to those unscrupulous health care insurance companies, Rx providers, doctors, and hospitals who made a sport out of bilking those in need of medical care and Rx and the federal Medicare & Medicaid programs. Hundreds of millions of dollars have recently been recovered from these rascals and settlements for many more millions of dollars are on the horizon. Gee, remember STRS's recent 4+ million dollar court-ordered settlement with Medco? It was a landmark case in which the PBM pricing lawsuit actually made it to court (and even made headlines in the Wall Street Journal). My, my ...... even in our own back yard!

Jim, congratulations for your investigating and questioning of this situation. Unfortunately, you are in the minority and thousands of STRS retirees don't have the drive, the guts, nor the health to pick up the phone and take Caremark to task for their errors.

The STRS is currently contracting for a company to aid them in the selection of a new PBM. I have given Damon Asbury a suggestion (and contact information) to check with the University of Michigan who recently inked an agreement with a PBM with a "transparent" contract which is open to public oversight -- one which has already saved the U. of M. over two million dollars in the short time it has been in existence (since Jan. 2006) while serving only 80,000 beneficiaries -- STRS has over 100,000 beneficiaries with their current Caremark contract. This "new" U. of M. contract is a result of a "thinking out of the box" mentality -- will STRS try this approach on their next contract? I guess we'll see......... John

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From Jim Kimmel, November 22, 2006
Subject: Caremark computer glitch

Recently Judy went in to get some prescriptions refilled. Each was with a $25.00 co-pay. Always had been. The clerk said "co-pay is zero". She questioned it and they rechecked and said that this is the co-pay Caremark had on the computer screen. So we got free prescriptions? No, not really!

I called Caremark and got confirmation that the co pay was $25 each I called STRS. STRS said to call Caremark again. After several wrestling matches with the female computer voice who could not recognize my last name "Kimmel" (to her I was "Mr. Kim") I got to a person who said call Kroger Pharmacy. Kroger's executive suite called Caremark 's "suits" and they both agreed we had to pay nothing. This went on for several days with each blaming the other. I finally got a supervisor and told him that the information had to originate at Caremark because they were the ones getting the big bucks from me to administer the program and get it right with the prices. The supervisor finally admitted that this has been a problem for a number of STRS people. Finally! My prescriptions went through OK, it was just Judy's that were "free", One of the Caremark people said not to worry and just consider it an early "Christmas present" That's when I asked for a supervisor!

At any rate (or rant) here is the bottom line of the problem: The computer system had added last year's accumulated out-of-pocket to Judy's 2006 out-of-pocket payments and concluded that she had met her $1500.00 out of pocket maximum and so stopped charging her for the rest of this year. Actually her out of pocket for 2006 so far (November) was only $700.00 and about $859 or so for 2005. so it stopped charging her. The supervisor admitted that a large number of people have been affected by this. He said in 3-5 business days it should be fixed. He tried to fix it but said he could not and would refer it to "Stephanie" and she would set things right and then do a mass download to correct the records of everyone affected. He gave me his first and last name so I think he was sincere. But next time Judy goes to the pharmacy she will have to pay the $50. Also, 3-5 business days would mean about November 30 - December range on the outside. Just be aware.

I THINK it is in process of getting straightened out. One just has to be persistent and not accept the superficial explanation some give to get you off their back. Caremark did give me a chance to talk to a supervisor who was very helpful. Note: Caremark paid Kroger pharmacy but had it wrong for the Co-Pay.

Jim and Judy Kimmel
STRS retirees